Become a part of our caring community
 

You will be focusing on provider data and claims resolution as the Senior Process Improvement Professional reporting to an Associate Director of Process Improvement.

Key Accountabilities -

• You will implement best business practices within and outside the organization to improve data quality and efficiency.

• You will collect and analyze process data to develop business practices and procedures that focus on increased productivity, reduced cost, awareness and resolution provider data exposure and deficiencies.

• You will support daily claim deferral process, daily workflow, and operational issue resolution.

• You will develop metrics that provide data for process measurement and identify indicators for future improvement opportunities.

• You will collect data to determine root cause of problems and measure performance against process requirements and aligns improvement to performance shortfalls.

• You will provide consultation on the use of re-engineering techniques to improve process performance and product quality.

Use your skills to make an impact
 

Required Qualifications

• Our Department of Defense Contract requires U.S. citizenship for this position

• Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Service)

• HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico.

• 3 years of claims operations experience, including experience with professional and institutional claims

• Experience with TRICARE claims processing and knowledge of TRICARE program

• Experience with Excel for data analysis and creating pivot tables

Preferred Qualifications

• Bachelor's degree

• Knowledge of TRICARE providers

• Business analysis, project, and process management experience

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$78,400 - $107,800 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 04-10-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.co